Sarcopenia (and sarcopenic obesity) in older patients with gynecological malignancies

Highlights

• Sarcopenia is very frequent in older patients with cancer and it is associated to many adverse outcomes.

• Sarcopenia could go under-detected, especially in overweight people, unless body composition assessment is performed.

• Implementing body composition analysis would help risk stratification and treatment of older patients with cancer.

Abstract

Cancer is often complicated by the deterioration of both muscle mass and function, which may be more pronounced in older people. The prevalence of sarcopenia varies according to tumour type, stage and sarcopenia definition; in gynaecologic malignancies it ranges from 25 to 50%. Unfortunately, sarcopenia is often underdiagnosed especially in overweight and obese patients. The consequences of sarcopenia are serious: shorter time of tumour progression, increased chemotherapy-related toxicity, post-operative complications, poor functional status, hospitalisation, increased length of hospital stay, high 30-day readmission rate and mortality. Therefore, its precocious recognition and treatment is of paramount importance. We demonstrated that obesity can mask sarcopenia, taking into consideration a sample of older patient with cancer, unless body composition evaluation and comprehensive geriatric assessment, including measures of muscle strength and performance, is executed. Our work underlines the importance of a multidisciplinary approach to older patients with cancer to optimize their management.

Introduction

Aging is characterized by a progressive decline in both muscle mass and function. Beyond a certain threshold this reduction is configured as a pathologic condition named sarcopenia [1]. Sarcopenia is more frequent among patients with cancer because of many factors concurring to the deterioration of muscles: inflammation, tumour-derived catabolic factors, malnutrition, reduced physical activity and the effect of cytotoxic and targeted treatment on muscle mass and quality.

The prevalence of sarcopenia varies according to tumour type, stage and sarcopenia definition [2]; in gynaecologic malignancies it ranges from 25 to 50% [[3], [4], [5]]. Sarcopenia can precede the neoplastic disease and further complicate its course predisposing to a shorter time of tumour progression, increased chemotherapy-related toxicity, post-operative complications, poor functional status, hospitalisation, increased length of hospital stay, high 30-day readmission rate and mortality [3].

Unfortunately, sarcopenia is often underdiagnosed: the global epidemics of overweight and obesity render particularly challenging to identify muscle loss. Nowadays between 40 and 60% of oncologic patients are overweight or obese, even in the setting of metastatic disease [6]. Body composition varies widely among people of identical body mass index (BMI) [3] who can display different percentages of lean and fat tissues. Some obese individuals have little muscle mass, comparable to very underweight patients.

Performing a comprehensive geriatric assessment (CGA) [7] helps in the early detection of sarcopenia and positively impacts on the management of older patients with cancer.

CGA implies a systematic evaluation of multiple domains (physical, cognitive, affective, social, financial, and environmental) influencing older adults' health. Therefore, CGA allows the evaluation of the major aetiologies of sarcopenia and helps its differentiation from other wasting conditions [1]. Moreover, CGA.

provides the basis for the development of tailored interventions. The major oncologic societies promote the CGA use [7] because its implementation is associated with more favourable outcomes.